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Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
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2006 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 90, no 2-3, 239-249 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Limited information is available on the outcome of bipolar disorder in developing countries.

OBJECTIVE: To describe the symptomatic and functional outcome of bipolar disorder.

METHODS: The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia. In addition, key informants were used to identify individuals with probable major mental illnesses. SCAN interviews were completed at the second stage to confirm the diagnosis. A total of 315 cases of bipolar disorder were identified, of which 264 (69 recent-onset and 195 prevalent cases) were prospectively followed for a mean of 2.5 (range 1-4) years by baseline and annual clinical assessments using symptom rating scales. Functional dimensions of the SF-36 scale were used to describe functional outcome. Random coefficient analyses were used to evaluate potential correlates of outcome.

RESULTS: The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up, although the improvement was less marked for depression. Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome. Between 35% and 47% of the recent-onset cases had functional role restrictions, while 42-52% of long-standing cases had such restrictions during the follow-up years. Similarly, social and physical functioning deficits were also present in 52-86% and 35-47% of recent-onset and long-standing cases, respectively. The magnitude of depression and mania symptoms was associated with poor functional outcome, while male sex, rural residence and being married were associated with better functional outcome.

CONCLUSION: Although there were improvements in function with follow-up, between one-third and one-half of cases continued to have functional deficits.

Place, publisher, year, edition, pages
2006. Vol. 90, no 2-3, 239-249 p.
Keyword [en]
Bipolar disorder; Outcome; Ethiopia
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
URN: urn:nbn:se:umu:diva-37808DOI: 10.1016/j.jad.2005.11.009PubMedID: 16376431OAI: oai:DiVA.org:umu-37808DiVA: diva2:370080
Available from: 2010-11-15 Created: 2010-11-15 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Studies on affective disorders in rural Ethiopia
Open this publication in new window or tab >>Studies on affective disorders in rural Ethiopia
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Affective disorders are poorly defined and studied in sub-Saharan Africa despite their substantial public health impact.

Objectives

Overall objective: To describe the epidemiology of selected affective disorders in rural Ethiopia.

Specific objectives

1. To describe the validity and utility of the concept of minor depressive disorder (mD).

2. To describe the manifestation, prevalence and the short-term clinical and functional course and outcome of bipolar disorder.

Subjects and methods

Population: Zay community residents (age ≥16), and residents of Butajira (ages 15-49), in Southern Ethiopia.

Study design: Population-based cross-sectional and longitudinal studies

Case identification: For the identification of cases with bipolar disorder, a two stage process was employed. An initial screen used key informants and interview with the Composite International Diagnostic Interview (CIDI) to identify cases with probable bipolar disorder. A second confirmatory diagnostic assessment stage employed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN). For the identification of cases with mD, data from the CIDI was used.

Follow-up: 312 cases with bipolar disorder from Butajira were followed up for a mean of 2.5 years (ranging 1-4 years) through monthly clinical assessments and annual symptom and functional ratings.

Results

The CIDI was administered to 1714 adults among the Zay and to 68, 378 adults among the Butajira residents. The prevalence of mD among the Zay and Butajira was 20.5% and 2.2% respectively. Up to 80% of cases with mD had used services for their symptoms, while a third to a half of cases had thought about self harm. Up to a sixth of cases had attempted suicide. Age, marital status, education and somatic symptoms were independently associated with mD.

The prevalence of bipolar disorder among the Zay was 1.8%. During a 2.5-year follow-up of 312 cases with bipolar disorder from Butajira, 65.9% relapsed (47.8% manic, 44.3% depressive and 7.7% mixed episodes) while 31.1% experienced persistent illness. Female gender predicted depressive relapse whereas male gender predicted manic relapse. Only being on psychotropic medication predicted remission (OR=3.42; 95% CI=1.82, 6.45). Disability was much worse among bipolar patients than in the general population and was predicted by symptom se3verity.

Conclusions

This is the largest study on mD and bipolar disorder in Africa. mD appears to have potential clinical utility in this setting given its association with service use and risk. The identified risk factors for mD also suggest potential aetiological continuity with major depression. The relatively high prevalence of bipolar disorder among the Zay may be related to genetic predisposition perhaps mediated through a founder effect, but other factors need exploring. In relation to the outcome of bipolar disorder, this study indicates that, contrary to previous assumptions, the course of bipolar disorder is characterised by both manic and depressive relapses in a relatively proportionate fashion. Bipolar disorder also leads to significant levels of disability. This is the only prospective outcome study of bipolar disorder in Africa where cases were monitored systematically at short assessment intervals. Therefore, findings are likely to be more robust than previous reports.

Place, publisher, year, edition, pages
Umeå: Umeå University, 2010. 79 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1381
Keyword
bipolar disorder, depressive disorder, affective disorder, mood disorder, prevalence, outcome, cross-sectional study, prospective study, longitudinal study, isolated population, Ethiopia, Africa, developing countries
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:umu:diva-37813 (URN)978-91-7459-103-3 (ISBN)
Public defence
2010-12-08, Sal A, våning 0, Psykiatriska kliniken, Umeå, 14:05 (English)
Opponent
Supervisors
Available from: 2010-11-18 Created: 2010-11-15 Last updated: 2010-11-18Bibliographically approved

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